Provider Demographics
NPI:1649010505
Name:PORTER, ELIZABETH ANNE (MS PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:PORTER
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4963 PLEASANT VALLEY RD SE
Mailing Address - Street 2:
Mailing Address - City:DENNISON
Mailing Address - State:OH
Mailing Address - Zip Code:44621-9041
Mailing Address - Country:US
Mailing Address - Phone:330-343-3311
Mailing Address - Fax:
Practice Address - Street 1:659 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2026
Practice Address - Country:US
Practice Address - Phone:330-343-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-010656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist